title: The changing pattern of amputations.
abstract: BACKGROUND
  Conflict in the Middle East over the past 10 years has seen a change in warfare tactics from the use of ballistic missiles to blast weapons, which has resulted in a well-documented change in wounding patterns. Due to the severity of these injuries, there have been large numbers of amputations, both as life and limb saving procedures. The purpose of this paper is to retrospectively review all UK service personnel who have undergone limb amputation in the last 8 years of conflict and compare those from the early years with the more recent.
  
  
  METHODS
  All UK service personnel scoring more than 1 on the extremity score of the Abbreviated Injury Score were identified from the UK Joint Theatre Trauma Registry and separated into two temporal cohorts (August 2003-February 2008 and August 2008-July 2010). Intheatre medical facility and Role 4 hospital notes from the Queen Elizabeth Hospital Birmingham were examined for details of mechanisms of injury, number of limbs injured, associated injuries, method of amputation, microbiology of contaminating organisms and outcome.
  
  
  RESULTS
  There were significant differences in the nature of the amputations, the number of multiple amputations and soft tissue perineal wounds, as well as a significantly higher Injury Severity Score in the later time period. There were also significant differences in the surgical techniques, with more guillotine amputations in the early group, and mechanism of injury, with more blast injuries in the late group.
  
  
  CONCLUSIONS
  This study has confirmed the clinical impression that there has been a significant change in the limb trauma from the Iraq conflict to Afghanistan. These injury patterns have significantly different logistic implications and this must be considered when planning the required medical assets in future conflicts.
authors.affiliation: Academic Department of Military Surgery and Trauma, ICT Research Park, Birmingham, UK.
authors.forename: Kate V
authors.initials: KV
authors.lastname: Brown
authors.forename: J C
authors.initials: JC
authors.lastname: Clasper
mesh_terms: D000671:Amputation, Surgical; D001753:Blast Injuries / Q000601:surgery; D005107:Explosions; D006801:Humans; D008889:Military Personnel; D012189:Retrospective Studies